Nurse practitioners want to fill new care demands

With a potential doctor shortage looming, nurse practitioners are trying to raise the profile of the 155,000 in their field.

WASHINGTON — President Barack Obama’s health-care law is expected to expand health insurance to 32 million Americans over the next decade. Health policy experts anticipate that the wave of new insurance subscribers will lead to a spike in demand for medical services.

That has a battle heating up over who will provide that care. Nurse practitioners are rolling out a campaign this week to explain what, exactly, nurse practitioners do — and why patients should trust them with their medical needs.

“We know that the Affordable Care Act will extend health coverage to millions of Americans,” said Penny Kaye Jensen, president of the American Academy of Nurse Practitioners (AANP). “It’s important for consumers to understand what we do and that we’re fully prepared to care for them.”

Through advertisements, public service announcements and events, the organization will try to raise the profile of the country’s 155,000 nurse practitioners.

The campaign looks to exploit what many say is a looming doctor shortage. The Association of American Medical College predicts that the country will have 63,000 too few doctors as soon as 2015.

“With the serious shortage of family doctors in many parts of the country, nurse practitioners — or NPs as they are known — can provide expert, compassionate and affordable care,” the group will contend in a radio public service announcement.

The AANP will follow up on the public relations blitz with state-level lobbying efforts, looking to pass bills that will expand the range of medical procedures that their membership can perform.

“A fully enabled nurse practitioner workforce will increase access to quality health care, improve outcomes and make the health-care system more affordable for patients all across America,” Jensen said.

All states have “scope of practice” laws, which regulate what medical procedures each profession can, and cannot, perform, given their level of education. These laws regulate everyone from dental hygienists to physician assistants up to nurse practitioners, who all hold graduate degrees in medical education.

In 16 states, nurse practitioners can practice without the supervision of another professional such as a doctor. Other states, however, require a physician to sign off on a nurse practitioner’s prescriptions, for example, or diagnostic tests.

As the health insurance expansion looms, expanding those rules to other states has become a crucial priority for nurse practitioners. “We’re all educated and prepared to provide a full range of services,” said Taynin Kopanos, AANP’s director of state government affairs.

The nurse practitioners’ campaign, however, is unlikely to move forward without a fight: doctors’ groups have often opposed such efforts of other professional societies to expand their medical authorities. The American Medical Association (AMA), which lobbies for doctors, often contends that such laws could put patients at risk.

“Non-physician professionals play vital roles in providing high-quality patient care, but no other health-care professionals’ education and training comes close to physicians’ more than 10 years of medical education and 16,000 hours of clinical experience,” AMA President Peter Carmel said.

Legislative analysts at the AMA say they’ve seen an uptick in state legislation meant to increase the powers of other professionals since the Affordable Care Act passed. Legislators have introduced about 400 such bills this year.

Nurse practitioners say they do have the skills necessary to treat patients with more autonomy. Unlike other nurses, all nurse practitioners hold either a master’s or doctorate degree in medical education.

Alongside the legislative push, the group also will focus on public education. Data suggest that they have their work cut out for them: A 2010 AANP poll found that while most Americans report having been seen by a nurse practitioner, few knew that their medical expertise goes beyond that of traditional, registered nurses, who go through less medical training.

Fourteen percent of the adults surveyed thought that nurse practitioners could prescribe medication, although sometimes with a physician’s supervision, an authority they have in all states. They can also order diagnostic tests and scans, such as X-rays and MRIs, but only 18 percent thought such powers were within their scope of practice.

“People stop at the word nurse and don’t understand the word practitioner,” Jensen said. “Obviously we are nurses, but we also have advanced education. We think there’s a misunderstanding on the patients’ behalf.”

Jensen hopes to see her members out at health fairs, church groups, rotary clubs and other community events to get the word out about the work they do, and the role they hope to fill as health insurance coverage expands.

“I think I was surprised about patients knowing so little, even if they’ve seen us,” she said. “That really was the springboard for this campaign, that we need to be expanding our visibility.”